The study aimed to compare the safety and effectiveness between fenestrated technique with or without chimney stent and single-branched stent-graft for isolated left subclavian artery (LSA) revascularization during endovascular repair of acute type B aortic dissection (ATBAD) with unfavorable proximal landing zone.
From January 2016 to December 2019, 65 ATBAD patients with unfavorable proximal landing zone were treated with either the fenestrated technique (n=34, group A) or single-branched stent-graft (n=31, group B). Type I endoleak, retrograde type A dissection, stroke, LSA patency, 30-day mortality, and aortic remodeling were systematically recorded and retrospectively analyzed.
Technical success rates for groups A and group B were 94.12% and 100%, respectively. LSA primary patency was achieved for all enrolled patients. The incidence of type I endoleak, retrograde type A dissection, stroke, and 30-day mortality was 5.9%, 5.9%, 2.9%, and 2.9% in group A, respectively, but none were encountered in group B. LSA Occlusion was observed in three and two patients during a mean follow-up of 16.18±2.08 and 15.19±2.68 months in groups A and B, respectively. After the procedure, significant aortic remodeling was detected in both groups during follow-up.
Both techniques are feasible and safe for isolated LSA revascularization during endovascular repair for ATBAD. Apart from the associated perioperative risks of complications and mortality for the fenestrated technique, both procedures contributed to favorable aortic remodeling.
Both techniques are feasible and safe for isolated LSA revascularization during endovascular repair for ATBAD. Apart from the associated perioperative risks of complications and mortality for the fenestrated technique, both procedures contributed to favorable aortic remodeling.Long-term cognitive impairment frequently occurs after critical illness; no treatments are known to improve long-term cognition.
Does a single high-dose (540,000 International Units) enteral treatment of vitamin D3 given shortly after hospital admission in critically ill patients who are vitamin D deficient improve long-term global cognition or executive function?
This study evaluated long-term cognitive outcomes among patients enrolled in a multicenter, blinded, randomized clinical trial comparing vitamin D3 treatment vsplacebo in critically ill adults with vitamin D deficiency. Global cognition was measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Executive function was measured with a composite score derived from three Delis-Kaplan Executive Function System subscales. Outcomes were assessed at a median of 443days (interquartile range, 390-482days) after randomization and were compared using multivariate proportional odds regression. Adjusted ORs of &gt; 1.0 would indicate better outcomes in the vitamin D3 group compared with the placebo group.
Ninety-five patients were enrolled, including 47 patients randomized to vitamin D3 treatment and 48 patients randomized to placebo. The adjusted median RBANS score at follow-up was 79.6 (95%CI, 73.0-84.0) in the vitamin D3 group and 82.1 (95%CI, 74.7-84.6) in the placebo group (adjusted OR, 0.83; 95%CI, 0.50-1.38). The adjusted median executive function composite scores were 8.1 (95%CI, 6.8-9.0) and 8.7 (95%CI, 7.4-9.3), respectively (adjusted OR, 0.72; 95%CI, 0.36-1.42).
In vitamin D-deficient, critically-ill adults, a large dose of enteral vitamin D3 did not improve long-term global cognition or executive function.
ClinicalTrials.gov; No. NCT03733418; URL www.clinicaltrials.gov.
ClinicalTrials.gov; No. NCT03733418; URL www.clinicaltrials.gov.Identification of pathologic changes in early and mild obstructive lung disease has shown the importance of the small airways and their contribution to symptoms. Indeed, significant small airways dysfunction has been found prior to any overt airway obstruction being detectable by conventional spirometry techniques. However, most therapies for the treatment of obstructive lung disease target the physiological changes and associated symptoms that result from chronic lung disease, rather than directly targeting the specific underlying causes of airflow disruption or the drivers of disease progression. In addition, although spirometry is the current standard for diagnosis and monitoring of response to therapy, the most widely used measure, FEV1 , does not align with the pathologic changes in early or mild disease and may not align with symptoms or exacerbation frequency in individual patient. Newer functional and imaging techniques allow more effective assessment of small airways dysfunction; however, significant gaps in our understanding remain. Improving our knowledge of the role of small airways dysfunction in early disease in the airways, along with the identification of novel end points to measure subclinical changes in this region (ie, those not captured as symptoms or identified through standard FEV1), may lead to the development of novel therapies that directly combat early airways disease processes with a view to slowing disease progression and reversing damage. This expert opinion paper discusses small airways disease in the context of asthma and COPD and highlight gaps in current knowledge that impede earlier identification of obstructive lung disease and the development and standardization of novel small airways-specific end points for use in clinical trials.Cisplatin (cis-dichloro-diammine platinum, CDDP) is a well-known chemotherapeutic drug against a broad spectrum of human malignancies. However, the clinical utility of this effective chemotherapy agent is dose limited by its toxic side effects such as nephrotoxicity and ototoxicity. Necroptosis is a form of programmed necrotic cell death that is mediated by serine/threonine kinases, RIPK1 and RIPK3, together with MLKL. https://www.selleckchem.com/products/orforglipron-ly3502970.html In this study, we identified that the multitargeted kinase inhibitor KW-2449 inhibited cisplatin-induced necroptosis, while potentiated cisplatin-induced apoptosis in cancer cells. Mechanistic studies indicated that KW-2449 directly inhibited RIPK1 kinase activity to block necroptosis. Oral administration of KW-2449 attenuated renal cell necrosis and reduced pro-inflammatory responses in mouse models of cisplatin-induced nephrotoxicity. Taken together, our study shows that KW-2449 is a novel necroptosis inhibitor by targeting RIPK1 kinase activity and has great clinic potential for the treatment of cisplatin-induced nephrotoxicity.